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Peng B, Ling L. Health service behaviors of migrants: A conceptual framework. Front Public Health 2023; 11:1043135. [PMID: 37124818 PMCID: PMC10140430 DOI: 10.3389/fpubh.2023.1043135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 03/14/2023] [Indexed: 05/02/2023] Open
Abstract
Universal health coverage is vital to the World Health Organization's (WHO's) efforts to ensure access to health as a human right. However, it has been reported that migrants, including both international immigrants and internal migrants, underuse health services. Establishing a conceptual framework to facilitate research on the health service behaviors (HSB) of migrants is particularly important. Many theoretical frameworks explaining the general population's HSB have been published; however, most theoretical frameworks on migrants' HSB only focus on international immigrants without the inclusion of internal migrants. Of note, internal migrants are much more abundant than immigrants, and this group faces similar barriers to HSB as immigrants do. Based on theoretical frameworks of immigrants' HSB and Anderson's behavior model, the author proposes a new conceptual framework of migrants' HSB that includes both immigrants and internal migrants. The new conceptual framework divides the determinants into macro-structural or contextual factors, health delivery system characteristics, and characteristics of the population at risk and describes subgroup-specific factors. The author added some variables and reclassified variables in some dimensions, including characteristics of health delivery systems and access to healthcare. The characteristics of health delivery systems comprise the volume, organization, quality, and cost of the health delivery system, while the characteristics of access to healthcare include time accessibility, geographic accessibility, and information accessibility. The outcomes of HSB have been expanded, and relationships between them have been reported. The mediating effects of some variables have also been described. This conceptual framework can facilitate a deep and comprehensive understanding of the HSB determination process for migrants, including internal migrants.
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Affiliation(s)
- Boli Peng
- Department of Actuarial Science, School of Insurance, Guangdong University of Finance, Guangzhou, China
| | - Li Ling
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
- Center for Migrant Health Policy, Sun Yat-sen University, Guangzhou, China
- *Correspondence: Li Ling,
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Shi S, Jiang Y. Does supplemental private health insurance incentivize household risky financial asset investment? Evidence from the China Household Financial Survey. INTERNATIONAL JOURNAL OF HEALTH ECONOMICS AND MANAGEMENT 2022; 22:369-421. [PMID: 35359194 DOI: 10.1007/s10754-022-09326-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 03/06/2022] [Indexed: 06/14/2023]
Abstract
Private health insurance (PHI) is considered a supplement to public medical insurance schemes in China. To the extent that PHI coverage may offset background risk by decreasing medical expenditure risk, it may also incentivize risky financial behaviors. However, empirical evidence confirming this theory is absent in China. We fill this void by examining the impact of supplemental PHI on household risky financial investment using data from the China Household Financial Survey (CHFS). In the first set of analyses, we used bivariate probit (BVP) models with instrumental variables (IVs) to examine the effects of PHI on the extensive margin of household risky financial investment. In the second set of analyses, we used Tobit models with a two-stage residual inclusion (2SRI) framework to examine the effects of PHI on the corresponding intensive margin. The results indicated that supplemental PHI increased the probability of holding risky financial assets. On top of that, PHI increased the percentage of total financial assets allocated to risky financial investment. Such effects were more pronounced on stocks than on other risky products. Our findings provided evidence that purchasing supplemental PHI in China may increase the risk tolerance of financial investment, and risk attitude is a mediating factor between PHI ownership and risky financial investment behavior.
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Affiliation(s)
- Si Shi
- School of Public Health (Shenzhen), Sun Yat-Sen University, 66 Gongchang Road, Guangming, Shenzhen, Guangdong, China
| | - Yawen Jiang
- School of Public Health (Shenzhen), Sun Yat-Sen University, 66 Gongchang Road, Guangming, Shenzhen, Guangdong, China.
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Gao L, Nie Y, Wang G, Li F. The impact of public health education on people's demand for commercial health insurance: Empirical evidence from China. Front Public Health 2022; 10:1053932. [PMID: 36408058 PMCID: PMC9669966 DOI: 10.3389/fpubh.2022.1053932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 10/10/2022] [Indexed: 11/05/2022] Open
Abstract
Public health education is gaining significance globally, and it is important for managing health risks. This study empirically analyzed the effect of public health education on people's demand for commercial health insurance. And we used the fixed effects and the mediating effect models, and instrumental variables regression in our research based on panel data of 31 provinces (including municipalities and autonomous regions) in China from year 2009 to 2019. The findings show that public health education significantly increases people's demand for commercial health insurance, and this effect remains significant when considering endogeneity and robustness. We further analyzed and found that the increased demand for commercial health insurance is caused by health literacy, health risk perceptions and health risk attitudes. Through heterogeneity analysis, we found that there were significant differences in the effects of public health education in regions with different demographic and socioeconomic characteristics. We found that the effect of health education on promoting people's demand for commercial health insurance is more obvious in regions with high levels of urbanization, proportion of men, education, economic development, medical resources, and social medical insurance coverage. Governments are supposed to take further measures to enhance the effectiveness of public health education, develop high-quality commercial health insurance, and continuously improve health risk coverage.
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Affiliation(s)
- Lifei Gao
- School of Economics, Beijing Technology and Business University, Beijing, China
| | - Ying Nie
- School of Insurance and Economics, University of International Business and Economics, Beijing, China,*Correspondence: Ying Nie
| | - Guojun Wang
- School of Insurance and Economics, University of International Business and Economics, Beijing, China
| | - Fei Li
- China Life Reinsurance Company Ltd., Beijing, China
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Wang H, Liang D, Zhang D, Hou Z. How does domestic migration pose a challenge in achieving equitable social health insurance benefits in China? A national cross-sectional study. BMJ Open 2022; 12:e060551. [PMID: 35998949 PMCID: PMC9403113 DOI: 10.1136/bmjopen-2021-060551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To evaluate the benefit distribution of social health insurance among domestic migrants in China. DESIGN A national cross-sectional survey. SETTING 348 cities from 32 provincial units in China. PARTICIPANTS 1165 domestic migrants who used inpatient care services in the city of a new residence and had social health insurance. PRIMARY AND SECONDARY OUTCOME MEASURES The probability of receiving reimbursements from social health insurance, the amounts and ratio of reimbursement received. RESULTS Among migrants who used inpatient care in 2013, only 67% received reimbursements from social health insurance, and the reimbursement amount only accounted for 47% of the inpatient care expenditure. The broader the geographical scope of migration, the lower the probability of receiving reimbursement and the reimbursement ratio, but the higher the reimbursement amount. Specifically, the probability of receiving reimbursements for those who migrated across cities or provinces was significantly lower by 14.7% or 26.0%, respectively, than those who migrated within a city. However, they received significantly higher reimbursement amounts by 33.4% or 27.2%, respectively, than those who migrated within a city. And those who migrated across provinces had the lowest reimbursement ratio, although not reaching significance level. CONCLUSIONS The unequal benefit distribution among domestic migrants may be attributed to the fragmented health insurance design that relies on localised administration, and later reimbursement approach that migrating patients pay for health services up-front and get reimbursement later from health insurance. To improve the equity in social health insurance benefits, China has been promoting the portability of social health insurance, immediate reimbursement for inpatient care used across regions, and a more integrated health insurance system. Efforts should also be made to control inflation of healthcare expenditures and prevent inverse government subsidies from out-migration regions to in-migration regions. This study has policy implications for China and other low/middle-income countries that experience rapid urbanisation and domestic migration.
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Affiliation(s)
- Haiqin Wang
- Administrative Office, The International Peace Maternity and Child Health Hospital of China Welfare Institute, Shanghai, China
- School of Public Health, NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China
| | - Di Liang
- School of Public Health, NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China
| | - Donglan Zhang
- Division of Health Services Research, Department of Foundations of Medicine, New York University Long Island School of Medicine, Mineola, New York, USA
| | - Zhiyuan Hou
- School of Public Health, NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China
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Min R, Fang Z, Zi C, Tang C, Fang P. Do Migrant Residents Really Achieve Health Equity by Obtaining Urban Hukou? A Comparative Study on Health Service Utilization and Urbanization in Central China. Front Public Health 2022; 10:784066. [PMID: 35480587 PMCID: PMC9037327 DOI: 10.3389/fpubh.2022.784066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 03/08/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction With more than 120 million rural-to-urban migrants, urbanization of the rural population requires deeply exploration in China. Objective This study focused on settled citizens who obtained urban Hukou (household registration) during urbanization and investigated their perceptions of health services in China. Method A cross-sectional comparison study with an original, closed questionnaire was conducted in two major cities of Hubei, central China, covering health status and both the satisfaction with and utilization of health services. In total, 863 residents with urban Hukou participated in this study; migrants formed the study group and original city residents formed the control group. Propensity score matching (PSM) was used to reduce choice bias in the analysis steps. Besides basic description of the data, ordinary least squares regression (OLS regression) was used to discover the relationship between basic demographic indicators and health expenditure. Results PSM yielded 290 effective pairs for analysis. The results indicated an improvement in health status for migrant residents (study group) with a higher average score of self-reported health status and lower prevalence of chronic diseases than the control group. These scores were also better than the standard urban level in central China. The study group showed a higher clinic visit utility (69.63%), lower hospitalization utility (8.28%), less convenience of health service utility, and lower health expenditure than the control group. For the study group, the biggest difference was observed in satisfaction with health service costs, which was the least improved aspect after they obtained urban Hukou. The regression results demonstrated that age, family size, living expenditures, and marital status impacted health costs in the overall model and the influences of these factors differed between the study and control groups. Conclusions Obtaining urban Hukou helps migrant residents to meet their health service needs and receive equal access to health services. However, after obtaining urban Hukou, migrants also face great pressure in terms of health consumption. This study therefore offers guidance on the next steps for progressing China's urbanization.
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Affiliation(s)
- Rui Min
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zi Fang
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | | | - Changmin Tang
- School of Management, Hubei University of Chinese Medicine, Wuhan, China
| | - Pengqian Fang
- Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Academy of Health Policy and Management, Huazhong University of Science and Technology, Wuhan, China
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Ma R, Zou L. Stillbirth trends by maternal sociodemographic characteristics among a large internal migrant population in Shenzhen, China, over a 10-year period: a retrospective study. BMC Public Health 2022; 22:325. [PMID: 35172785 PMCID: PMC8848954 DOI: 10.1186/s12889-022-12734-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 01/31/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cities such as Shenzhen in southern China have large immigrant populations, and the reproductive health issues of pregnant women in these populations have not received sufficient attention. Stillbirth seriously threatens their health and is becoming a social issue worthy of attention. We conducted this study to estimate the trend in stillbirths at 28 or more gestational weeks and the related sociodemographic characteristics of pregnant women among a large internal migrant population in South China. METHODS A stillbirth is defined as a baby born with no signs of life after a given threshold, and are restricted to births of 28 weeks of gestation or longer, with a birth weight of at least 1000 g for international comparison. A population-based retrospective cohort of all births from January 2010 to December 2019 in Baoan, Shenzhen, was conducted using the Shenzhen Birth Registry Database. The overall stillbirth rate and year-specific stillbirth rate were calculated as the number of foetal deaths ≥28 gestational weeks or a birth weight ≥ 1000 g divided by the number of births over the last decade or in each year, respectively. The associations between the risk of stillbirth and maternal sociodemographic status were assessed using logistic regression. Spearman's rank correlation was calculated to evaluate the correlation between the economic status of the maternal birthplace and the stillbirth. RESULTS An overall stillbirth rate of 4.5 per 1000 births was estimated in a total of 492,184 births in our final analysis. Migrant women accounted for 87% of the total population but had a higher stillbirth rate (4.8 per 1000 births) than the permanent population (2.8 per 1000 births). The stillbirth rate varied by region of maternal birthplace, from 4.1 per 1000 births in women from East China to 5.7 per 1000 births in women from West China. The GDP per capita of the maternal birthplace was strongly correlated with the stillbirth rate. CONCLUSIONS Large disparities in the stillbirth rate exist between migrant and permanent populations and among regions of maternal birthplace in China. Strategies targeting migrant women based on their maternal birthplace are needed to further reduce the burden of stillbirth.
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Affiliation(s)
- Rui Ma
- Institute of Women's and Children's Health Care, Shenzhen Baoan Women's and Children's Hospital, Jinan University, Shenzhen, China
| | - Lingyun Zou
- Institute of Women's and Children's Health Care, Shenzhen Baoan Women's and Children's Hospital, Jinan University, Shenzhen, China.
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Wang J, Zhu J, Wang X, Che Y, Bai Y, Liu J. Sociodemographic disparities in the establishment of health records among 0.5 million migrants from 2014 to 2017 in China: a nationwide cross-sectional study. Int J Equity Health 2021; 20:250. [PMID: 34856984 PMCID: PMC8638552 DOI: 10.1186/s12939-021-01584-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 11/01/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Migrants account for a large part of China's population. Many policies and inventions have been taken to improve access to public health services and the health of migrants. China's Basic Public Health Services(BPHS) are a series of public health services in this policy domain, which aims at promoting the access of public health sevices and improve health equity of residents. The establishment of health records is the fundamental service of BPHS. However, there is little known about the establishment of health records among migrants in China, which hinders the more efficient provision of health services for migrants, and health equity is difficult to achieve. Based on the research gap, this study aims at showing the sociodemographic disparities in the establishment rate of health records, and identifying priorities and recommendations for promoting health equity of migrants in China. METHODS This study used national data from China Migrants Dynamic Survey (CMDS) from 2014 to 2017 to evaluate the sociodemographic disparities in the establishment rate of health records and utilization of relevant public health services. The study included 539,926 respondents. Following the descriptive statistics of migrants, we showed the establishment rate of health records by sociodemographic characteristics and migrating related characteristics. Multivariate analysis was conducted to explore the associations between sociodemographic charicteristics, migrating related charicteristics and the establishment of health records. RESULTS The establishment rate of health records among migrants in the sampled years were 22.99, 38.44, 27.29% respectively, and 29.18% in general, and there existed heterogeneity in the establishment rate of health records by sociodemographic charicteristics and migrating related charicteristics. Female migrants who were older, from middle age, married or living with partner, with higher educational attainment, with urban household registration, migrated for longer time, migrated for the reason of studying or family issues, migrated in province were more likely to establish health records. CONCLUSION There existed sociodemographic disparities in the establishment rate of health records and inequalities in the utilization of health records services among migrants in China. Migrating related characteristics also had impact on the establishment status. Policies should take both supply side and demand side of health services to improve the health equity of migrants, which means that relative departments should continue to invest in primary healthcare centers to improve their ability to provide services as well as migrants' health literacy.
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Affiliation(s)
- Jun Wang
- Center for Health Policy Research and Evaluation, Renmin University of China, Beijing, 100872 China
| | - Jingmin Zhu
- Department of Economics, University of Birmingham, B15 2TT, Birmingham, UK
| | - Xueyao Wang
- Center for Health Policy Research and Evaluation, Renmin University of China, Beijing, 100872 China
| | - Yue Che
- Center for Health Policy Research and Evaluation, Renmin University of China, Beijing, 100872 China
| | - Yang Bai
- Center for Health Policy Research and Evaluation, Renmin University of China, Beijing, 100872 China
| | - Jue Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Centre, Beijing, 100080 China
- Institute for Global Health and Development, Peking University, Beijing, 100871 China
- Key Laboratory of Reproductive Health, National Health Commission of the People’s Republic of China, Beijing, 100083 China
- School of Public Health, Peking University; Institute for Global Health and Development, Peking University, Beijing, 100191 China
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Luo D, Deng J, Becker ER. Urban-rural differences in healthcare utilization among beneficiaries in China's new cooperative medical scheme. BMC Public Health 2021; 21:1519. [PMID: 34362340 PMCID: PMC8348873 DOI: 10.1186/s12889-021-11573-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 07/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The New Cooperative Medical Scheme (NCMS) is a voluntary social health insurance program launched in 2002 for rural Chinese residents where 80% of people were without health insurance of any kind. Over time, several concerns about this program have been raised related to healthcare utilization disparities for NCMS participants in urban versus rural regions. Our study uses 2015 national survey data to evaluate the extent of these urban and rural disparities among NCMS beneficiaries. METHODS Data for our study are based on the Chinese Health and Retirement Longitudinal Study (CHARLS) for 2015. Our 12,190-patient sample are urban and rural patients insured by NCMS. We use logistic regression analyses to compare the extent of disparities for urban and rural residence of NCMS beneficiaries in (1) whether individuals received any inpatient or outpatient care during 2015 and (2) for those individuals that did receive care, the extent of the variation in the number of inpatient and outpatient visits among each group. RESULTS Our regression results reveal that for urban and rural NCMS patients in 2015, there were no significant differences in inpatient or outpatient utilization for either of the dependent variables - 1) whether or not the patient had a visit during the last year, or 2) for those that had a visit, the number of visits they had. Patient characteristics: age, sex, employment, health status, chronic conditions, and per capita annual expenditures - all had significant impacts on whether or not there was an inpatient or outpatient visit but less influence on the number of inpatient or outpatient visits. CONCLUSIONS For both access to inpatient and outpatient facilities and the level of utilization of these facilities, our results reveal that both urban and rural NCMS patients have similar levels of resource utilization. These results from 2015 indicate that utilization angst about urban and rural disparities in NCMS patients do not appear to be a significant concern.
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Affiliation(s)
- Dian Luo
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Jing Deng
- School of Public Health and Management, Chongqing Medical University, Chongqing, China.,The Research Center for Medicine and Social Development, The Collaborative Innovation Center for Social Risk Governance in Health, Chongqing, China
| | - Edmund R Becker
- Department of Health Policy and Management, Rollins School of Public Health at Emory University, 1518 Clifton Road NE, 30322, Atlanta, GA, USA.
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Yang M, Hagenauer J, Dijst M, Helbich M. Assessing the perceived changes in neighborhood physical and social environments and how they are associated with Chinese internal migrants' mental health. BMC Public Health 2021; 21:1240. [PMID: 34182975 PMCID: PMC8240258 DOI: 10.1186/s12889-021-11289-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 06/09/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Migrants experience substantial changes in their neighborhood physical and social environments along their migration journeys, but little is known about how perceived changes in their neighborhood environment pre- and post-migration correlate with their mental health. Our aim was to examine the associations between recalled changes in the perceived neighborhood physical and social environments and migrants' mental health in the host city. METHODS We used cross-sectional data on 591 migrants in Shenzhen, China. We assessed their risk of mental illness using the General Health Questionnaire (GHQ). Neighborhood perceptions were collected retrospectively pre- and post-migration. We used random forests to analyze possibly non-linear associations between GHQ scores and changes in the neighborhood environment, variable importance, and for exploratory analysis of variable interactions. RESULTS Perceived changes in neighborhood aesthetics, safety, and green space were non-linearly associated with migrants' mental health: A decline in these characteristics was associated with poor mental health, while improvements in them were unrelated to mental health benefits. Variable importance showed that change in safety was the most influential neighborhood characteristic, although individual-level characteristics-such as self-reported physical health, personal income, and hukou (i.e., the Chinese household registration system)-appeared to be more important to explain GHQ scores and also strongly interacted with other variables. For physical health, we found different associations between changes in the neighborhood provoked by migration and mental health. CONCLUSION Our findings suggest that perceived degradations in the physical environment are related to poorer post-migration mental health. In addition, it seems that perceived changes in the neighborhood environment play a minor role compared to individual-level characteristics, in particular migrants' physical health condition. Replication of our findings in longitudinal settings is needed to exclude reverse causality.
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Affiliation(s)
- Min Yang
- Department of Human Geography and Spatial Planning, Faculty of Geosciences, Utrecht University, Princetonlaan 8A, Utrecht, CB 3584 The Netherlands
| | - Julian Hagenauer
- Department of Human Geography and Spatial Planning, Faculty of Geosciences, Utrecht University, Princetonlaan 8A, Utrecht, CB 3584 The Netherlands
| | - Martin Dijst
- LISER, Luxembourg Institute of Socio-Economic Research, Esch-sur-Alzette, Luxembourg
- University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Marco Helbich
- Department of Human Geography and Spatial Planning, Faculty of Geosciences, Utrecht University, Princetonlaan 8A, Utrecht, CB 3584 The Netherlands
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Shen M, Wu Y, Xiang X. Hukou-based rural-urban disparities in maternal health service utilization and delivery modes in two Chinese cities in Guangdong Province. Int J Equity Health 2021; 20:145. [PMID: 34158068 PMCID: PMC8218440 DOI: 10.1186/s12939-021-01485-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 06/01/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Most existing research on rural-urban health inequalities focuses on disparities in service access and health outcomes based on region. This paper examines rural-urban disparities in maternal healthcare utilization and delivery modes based on household registration (hukou) status to understand the role of state institutions in producing healthcare disparities in China. METHODS Utilizing administrative data from the Public Maternal Health Insurance scheme, we analyzed 54,733 live births in City A (2015-2019) and 25,849 live births in City B (2018-2019) in Guangdong Province in China. We constructed regression models using hukou status (rural versus urban) as the explanatory variable. RESULTS While there is no statistically significant difference in rural and urban mothers' probability of obtaining the minimum recommended number of prenatal care checkups in City A (OR = 0.990 [0.950, 1.032]), mothers with rural hukou status have a lower probability of obtaining the minimum recommended number of visits in City B than their counterparts with urban hukou (OR = 0.781 [0.740, 0.825]). The probability of delivering in tertiary hospital is lower among mothers with rural hukou than among those with urban hukou in both cities (City A: OR = 0.734 [0.701, 0.769]; City B: OR = 0.336 [0.319, 0.354]). Mothers with rural hukou are more likely to have a Cesarean section than those with urban hukou in both cities (City A: OR = 1.065 [1.027, 1.104]; City B: OR = 1.127 [1.069, 1.189]). Compared with mothers with urban hukou, mothers with rural hukou incurred 4 % (95 % CI [-0.046, -0.033]) and 9.4 % (95 % CI [-0.120, -0.068]) less in total medical costs for those who delivered via Cesarean section and 7.8 % (95 % CI [-0.085, -0.071]) and 19.9 % (95 % CI [-0.221, -0.177]) less for those who delivered via natural delivery in City A and City B, respectively. CONCLUSIONS Rural hukou status is associated with younger age, no difference or lower probability of having a minimum number of prenatal checkups, higher likelihood of delivering in nontertiary hospitals, increased Cesarean delivery rates, and lower medical cost for delivery in these two Chinese cities. Evaluating how hukou status influences maternal healthcare in Chinese cities is important for devising targeted public policies to promote more equitable maternal health services.
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Affiliation(s)
- Menghan Shen
- Center for Chinese Public Administration Research, School of Government, Sun Yat-sen University, Guangzhou, China
| | - Yushan Wu
- The Jockey Club School of Public Health and Primary Care, Chinese University of Hong Kong, Shatin, N. T. HKSAR, China
| | - Xin Xiang
- Graduate School of Education, Harvard University, 14 Appian Way, MA, 02139, Cambridge, USA.
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Lin Y, Chu C, Chen Q, Xiao J, Wan C. Factors influencing utilization of primary health care by elderly internal migrants in China: the role of social contacts. BMC Public Health 2020; 20:1054. [PMID: 32620098 PMCID: PMC7333340 DOI: 10.1186/s12889-020-09178-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 06/29/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Utilization of primary health care is an important aspect of elderly internal migrants' access to screening and preventive services in China. It has been evident that social contacts, such as community engagement, social mobilization, and the ability to communicate were related to health service delivery, but little has been done to explore the relationship between social contacts and utilization of primary health care for this group. This study aimed to explore the factors influencing utilization of primary health care from the perspective of social contacts among elderly internal migrants in China. METHODS This was a cross-sectional study including 1544 elderly internal migrants in eight cities. Whether these indivdiuals had chosen to participate in the free health checkup organized in the previous year was adopted as an indicator of the utilization of primary health care. The number of local friends and amount of exercise time per day were measured as a proxy for social contacts. Multivariate binary logistic regression was used to investigate the association of social contacts with the likelihood of using primary health care. RESULTS 55.6% of the respondents were men, and the mean age was 66.34 years (SD, 5.94). 88.6% had received an education of high school or below. 12.9% had no local friends. 5.2% did not exercise. Just 33.1% had participated in a free medical check-up. Social contacts, age, and medical insurance were associated with more use of primary health care among elderly internal migrants in China. CONCLUSION The role of the community in promoting the use of primary health care should be expanded, such as creating community-based campaigns specifically targeting elderly internal migrants or designing social or sports activities tailored to increase the opportunity for contact between local elders and their internal migrant peers.
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Affiliation(s)
- Yanwei Lin
- Department of Health Sociology, School of Humanities and Management, Guangdong Medical University, Dongguan, China
- School of Humanities and Management, Research Center for Quality of Life and Applied Psychology, Guangdong Medical University, 1#, Xincheng Avenue, Songshanhu District, Dongguan, Guangdong, China
| | - Chengjing Chu
- Department of Health Sociology, School of Humanities and Management, Guangdong Medical University, Dongguan, China
| | - Qin Chen
- Department of Management and Law, School of Humanities and Management, Guangdong Medical University, Dongguan, China
| | - Junhui Xiao
- Department of Management and Law, School of Humanities and Management, Guangdong Medical University, Dongguan, China
| | - Chonghua Wan
- School of Humanities and Management, Research Center for Quality of Life and Applied Psychology, Guangdong Medical University, 1#, Xincheng Avenue, Songshanhu District, Dongguan, Guangdong, China.
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The Effects of Private Health Insurance on Universal Health Coverage Objectives in China: A Systematic Literature Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020. [PMID: 32204527 DOI: 10.3390/ijerph17062049.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND We conducted a systematic review on the role of private health insurance to complement the social health insurance system towards achieving universal health coverage in China. This review presents the impacts of private health insurance on expanding coverage, increasing access to healthcare, and financial protection. METHODS A systematic review was conducted by searching peer-reviewed articles published between January 2000 and March 2018 in Web of Science, PubMed, and China Knowledge Resource Integrated Database. The search terms included coverage prevalence, access and financial protection related to private health insurance in China. A total of 31 studies were selected. RESULTS Coverage prevalence of private health insurance gradually increased but it was unequally distributed across regions and populations. The expansion of social health insurance has enhanced the total aggregate premium of private health insurance but has had a mixed impact on the take-up of private health insurance. Private insurance beneficiaries were found to limit their utilisation of healthcare services and there was no evidence that it ensured financial protection. CONCLUSION The role of private health insurance (PHI) in extending universal health coverage in China was limited and therefore should not be overstated.
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Wu R, Li N, Ercia A. The Effects of Private Health Insurance on Universal Health Coverage Objectives in China: A Systematic Literature Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E2049. [PMID: 32204527 PMCID: PMC7142974 DOI: 10.3390/ijerph17062049] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 03/16/2020] [Accepted: 03/17/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND We conducted a systematic review on the role of private health insurance to complement the social health insurance system towards achieving universal health coverage in China. This review presents the impacts of private health insurance on expanding coverage, increasing access to healthcare, and financial protection. METHODS A systematic review was conducted by searching peer-reviewed articles published between January 2000 and March 2018 in Web of Science, PubMed, and China Knowledge Resource Integrated Database. The search terms included coverage prevalence, access and financial protection related to private health insurance in China. A total of 31 studies were selected. RESULTS Coverage prevalence of private health insurance gradually increased but it was unequally distributed across regions and populations. The expansion of social health insurance has enhanced the total aggregate premium of private health insurance but has had a mixed impact on the take-up of private health insurance. Private insurance beneficiaries were found to limit their utilisation of healthcare services and there was no evidence that it ensured financial protection. CONCLUSION The role of private health insurance (PHI) in extending universal health coverage in China was limited and therefore should not be overstated.
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Affiliation(s)
- Runguo Wu
- Institute of Population Health Sciences, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AB, UK
- Global Health Policy Unit, School of Social and Political Science, University of Edinburgh, Edinburgh EH8 9LD, UK
| | - Niying Li
- School of Pharmacy, University of Wisconsin-Madison, Madison, WI 53705, USA;
| | - Angelo Ercia
- Division of Informatics, Imaging & Data Sciences, School of Health Sciences, the University of Manchester, M13 9PL Manchester, UK;
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Kaitelidou D, Galanis P, Economou C, Mladovsky P, Siskou O, Sourtzi P. Inequalities Between Migrants and Non-Migrants in Accessing and Using Health Services in Greece During an Era of Economic Hardship. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2020; 50:444-457. [PMID: 32028832 DOI: 10.1177/0020731420902604] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A cross-sectional study was conducted from April 2013 until March 2014 to explore the existence of inequalities in access to and utilization of health services by migrants compared to non-migrants in Greece and to test the influence of various factors on these disparities. Also, we investigated the influence of several socioeconomic and demographic characteristics. Study population included 1,152 migrants and 702 non-migrants. Migrants, participants suffering from a chronic disease, those without health insurance, and patients who assessed their health status as not at all good/a little good/moderate were statistically more likely to report unmet needs in getting their medication. Uninsured participants, females, those unemployed or without a permanent occupational status, and those who assessed their health status as not at all good/a little good/moderate were statistically more likely to report unmet needs in access to health services during the last year. Regarding the use of health services, those with health coverage, non-migrants, and females were statistically more likely to go for a blood test as a hospital outpatient. Greece, despite administrative delays and barriers, provided full coverage to the uninsured, asylum seekers, and migrants, even many groups of undocumented migrants.
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Affiliation(s)
- Daphne Kaitelidou
- Department of Nursing, Center for Health Services Management and Evaluation, National and Kapodistrian University of Athens, Athens, Greece
| | - Petros Galanis
- Department of Nursing, Center for Health Services Management and Evaluation, National and Kapodistrian University of Athens, Athens, Greece
| | - Charalambos Economou
- Department of Sociology, Panteion University of Social and Political Sciences, Athens, Greece
| | - Philipa Mladovsky
- Department of International Development, London School of Economics and Political Science, London, UK
| | - Olga Siskou
- Department of Nursing, Center for Health Services Management and Evaluation, National and Kapodistrian University of Athens, Athens, Greece
| | - Panayota Sourtzi
- Department of Nursing, Sector of Public Health, Occupational Health Nursing, National and Kapodistrian University of Athens, Athens, Greece
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Wang Z, Nie K. Measuring Spatial Patterns of Health Care Facilities and Their Relationships with Hypertension Inpatients in a Network-Constrained Urban System. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16173204. [PMID: 31480759 PMCID: PMC6747080 DOI: 10.3390/ijerph16173204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 07/19/2019] [Accepted: 08/29/2019] [Indexed: 12/03/2022]
Abstract
There is evidence of a strong correlation between inequality in health care access and disparities in chronic health conditions. Equal access to health care is an important indicator for overall population health, and the urban road network has a significant influence on the spatial distribution of urban service facilities. In this study, the network kernel density estimation was applied to detect the hot spots of health care service along the road network of Shenzhen, and we further explored the influences of population and road density on the aggregate intensity distributions at the community level, using spatial stratified heterogeneity analyses. Then, we measured the spatial clustering patterns of health care facilities in each of the ten districts of Shenzhen using the network K-function, and the interrelationships between health care facilities and hypertension patients. The results can be used to examine the reasonability of the existing health care system, which would be valuable for developing more effective prevention, control, and treatment of chronic health conditions. Further research should consider the influence of nonspatial factors on health care service access.
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Affiliation(s)
- Zhensheng Wang
- Key Laboratory of Urban Land Resources Monitoring and Simulation, Ministry of Land and Resources of China, Shenzhen 518034, China.
- Key Laboratory for Geo-Environmental Monitoring of Coastal Zone of the Ministry of Natural Resources & Guangdong Key Laboratory of Urban Informatics & Shenzhen Key Laboratory of Spatial Smart Sensing and Services, Shenzhen University, Shenzhen 518060, China.
- College of Civil and Transportation Engineering, Shenzhen University, Shenzhen 518060, China.
- Research Institute for Smart Cities, School of Architecture and Urban Planning, Shenzhen University, Shenzhen 518060, China.
| | - Ke Nie
- Key Laboratory of Urban Land Resources Monitoring and Simulation, Ministry of Land and Resources of China, Shenzhen 518034, China
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van Hees SGM, O'Fallon T, Hofker M, Dekker M, Polack S, Banks LM, Spaan EJAM. Leaving no one behind? Social inclusion of health insurance in low- and middle-income countries: a systematic review. Int J Equity Health 2019; 18:134. [PMID: 31462303 PMCID: PMC6714392 DOI: 10.1186/s12939-019-1040-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 08/19/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND One way to achieve universal health coverage (UHC) in low- and middle-income countries (LMIC) is the implementation of health insurance schemes. A robust and up to date overview of empirical evidence assessing and substantiating health equity impact of health insurance schemes among specific vulnerable populations in LMICs beyond the more common parameters, such as income level, is lacking. We fill this gap by conducting a systematic review of how social inclusion affects access to equitable health financing arrangements in LMIC. METHODS We searched 11 databases to identify peer-reviewed studies published in English between January 1995 and January 2018 that addressed the enrolment and impact of health insurance in LMIC for the following vulnerable groups: female-headed households, children with special needs, older adults, youth, ethnic minorities, migrants, and those with a disability or chronic illness. We assessed health insurance enrolment patterns of these population groups and its impact on health care utilization, financial protection, health outcomes and quality of care. RESULTS The comprehensive database search resulted in 44 studies, in which chronically ill were mostly reported (67%), followed by older adults (33%). Scarce and inconsistent evidence is available for individuals with disabilities, female-headed households, ethnic minorities and displaced populations, and no studies were yielded reporting on youth or children with special needs. Enrolment rates seemed higher among chronically ill and mixed or insufficient results are observed for the other groups. Most studies reporting on health care utilization found an increase in health care utilization for insured individuals with a disability or chronic illness and older adults. In general, health insurance schemes seemed to prevent catastrophic health expenditures to a certain extent. However, reimbursements rates were very low and vulnerable individuals had increased out of pocket payments. CONCLUSION Despite a sizeable literature published on health insurance, there is a dearth of good quality evidence, especially on equity and the inclusion of specific vulnerable groups in LMIC. Evidence should be strengthened within health care reform to achieve UHC, by redefining and assessing vulnerability as a multidimensional process and the investigation of mechanisms that are more context specific.
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Affiliation(s)
- Suzanne G M van Hees
- Radboud Institute for Health Sciences (RIHS), Department for Health Evidence, Radboud University Medical Centre, Nijmegen, The Netherlands.
- Department of Work and Health, HAN University of Applied Sciences, Kapittelweg 33, P.O. Box 6960, 6503GL, Nijmegen, Netherlands.
| | - Timothy O'Fallon
- International Centre for Evidence in Disability, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Marleen Dekker
- African Studies Center, Leiden University, Leiden, The Netherlands
| | - Sarah Polack
- International Centre for Evidence in Disability, London School of Hygiene and Tropical Medicine, London, UK
| | - Lena Morgon Banks
- International Centre for Evidence in Disability, London School of Hygiene and Tropical Medicine, London, UK
| | - Ernst J A M Spaan
- Radboud Institute for Health Sciences (RIHS), Department for Health Evidence, Radboud University Medical Centre, Nijmegen, The Netherlands
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Yuan B, Li J, Wu L, Wang Z. Multi-Level Social Health Insurance System in the Age of Frequent Employment Change: The Urban Unemployment-Induced Insurance Transition and Healthcare Utilization in China. Healthcare (Basel) 2019; 7:healthcare7020077. [PMID: 31200482 PMCID: PMC6627781 DOI: 10.3390/healthcare7020077] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 05/30/2019] [Accepted: 06/11/2019] [Indexed: 11/27/2022] Open
Abstract
Job tenure has been significantly shortened with the prevalence of the gig economy around the world. Workers are faced with a new age of frequent employment change. This emerging situation is out of expectation of social health insurance policymakers. As the multi-level social health insurance system in China is closely associated with employment status; urban workers cannot enjoy the urban employee basic medical insurance (UEBMI) during the unemployment period. At this time, unemployed rural-to-urban migrant workers can only rely on the new cooperative medical scheme (NCMS) and unemployed urban residents can only rely on the urban resident basic medical insurance (URBMI). This study provides a preliminary analysis on healthcare utilization change triggered by the unemployment-induced social health insurance transition that has never been investigated. Using the data of a nationwide survey, empirical results show that the unemployment-induced social health insurance transition can significantly deteriorate the healthcare utilization of insurance beneficiaries experiencing the transitions from the UEBMI to the NCMS (or from the UEBMI to the URBMI). Specifically, the outpatient service quality and the conventional physical examination become worse, and the out-of-pocket expenditure increases. Therefore, the multi-level social health insurance system currently in effect can expose workers to a high risk of insufficient health security in the age of frequent employment change.
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Affiliation(s)
- Bocong Yuan
- Center for Tourism Development Planning and Research, School of Tourism Management, Sun Yat-sen University, West Xingang Rd. 135, Guangzhou 510275, China.
| | - Jiannan Li
- International School of Business & Finance, Sun Yat-sen University, West Xingang Rd. 135, Guangzhou 510275, China.
| | - Lily Wu
- Center for Tourism Development Planning and Research, School of Tourism Management, Sun Yat-sen University, West Xingang Rd. 135, Guangzhou 510275, China.
| | - Zhaoguo Wang
- School of Economics and Management, Shenyang Agricultural University, Shenyang 110041, China.
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Yuan B, Li J, Wang Z, Wu L. Household Registration System, Migration, and Inequity in Healthcare Access. Healthcare (Basel) 2019; 7:healthcare7020061. [PMID: 30979025 PMCID: PMC6627074 DOI: 10.3390/healthcare7020061] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 04/03/2019] [Accepted: 04/09/2019] [Indexed: 11/16/2022] Open
Abstract
This study investigates the influence of the household registration system on rural–urban disparity in healthcare access (including healthcare quality, blood pressure check, blood test, vision test, dental examination, and breast exam), using data from a large-scale nationwide life history survey that covered 150 counties across 28 provinces and municipalities in China. In contrast to the findings of many previous studies that emphasize the disparity in the residence place as the cause of rural–urban disparity in healthcare access, this study finds that the residence place just has a very limited influence on healthcare access in China, and what really matters is the household registration type. Our empirical results show that people with a non-rural household registration type generally have better healthcare access than those with a rural one. For rural residents, changing the registration type of their household (from rural to non-rural) can improve their healthcare access, whereas changing the residence place or migrating from rural to urban areas have no effect. Therefore, mere rural-to-urban migration may not be a valid measure to eliminate the rural–urban disparity in healthcare access, unless the institution of healthcare resource allocation is reformed.
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Affiliation(s)
- Bocong Yuan
- Faculty of Economics and Management, Sun Yat-sen University, West Xingang Rd. 135, Guangzhou 510275, China.
| | - Jiannan Li
- Faculty of Economics and Management, Sun Yat-sen University, West Xingang Rd. 135, Guangzhou 510275, China.
| | - Zhaoguo Wang
- Faculty of Economics and Management, Sun Yat-sen University, West Xingang Rd. 135, Guangzhou 510275, China.
| | - Lily Wu
- Faculty of Economics and Management, Sun Yat-sen University, West Xingang Rd. 135, Guangzhou 510275, China.
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19
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Peng BL, Ling L. Association between rural-to-urban migrants' social medical insurance, social integration and their medical return in China: a nationally representative cross-sectional data analysis. BMC Public Health 2019; 19:86. [PMID: 30658619 PMCID: PMC6339269 DOI: 10.1186/s12889-019-6416-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Accepted: 01/08/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Without social medical insurance in the destination areas and with low social integration, rural-to-urban migrants had barriers to health service in the destination areas, some of the migrants had to seek health service in hometown, namely medical return. This study aimed at exploring the association between rural-to-urban migrants' medical return and social medical insurance type or social integration. METHODS We analysed a secondary cross-sectional data of the 2014 National Internal Migrant Dynamic Monitoring Survey collected in May of 2014 from all provinces or regions in mainland China. The medical return was measured by the location of hospitalisation, and the social integration included economic integration and permanent settlement intention. RESULTS Four thousand eighteen rural-to-urban migrants living in current residence at least one year and used inpatient service within the last 12 months were analysed. The rate of medical return for inpatient service was 15.3%. Having medical insurance of hometown (new rural cooperative medical scheme (NRCMS)) (OR = 2.44, 95%CIs 1.80-3.30) was positively related to the medical return. The permanent settlement intention was negatively associated with the medical return (OR = 0.66, 95%CIs 0.48-0.90). CONCLUSIONS Social medical insurance of hometown (NRCMS) was positively associated with the medical return, while the permanent settlement intention was negatively associated with it. Promoting the transfer of migrants' social medical insurance across different regions might be helpful to improve rural-to-urban migrants' health access.
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Affiliation(s)
- Bo-Li Peng
- Faculty of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China.,Center for Migrant Health Policy, Sun Yat-sen University, Guangzhou, China
| | - Li Ling
- Faculty of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China. .,Center for Migrant Health Policy, Sun Yat-sen University, Guangzhou, China.
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Guan M. Epidemiology of Hypertensive State among Chinese Migrants: Effects of Unaffordable Medical Care. Int J Hypertens 2018; 2018:5231048. [PMID: 30002926 PMCID: PMC5996430 DOI: 10.1155/2018/5231048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 04/06/2018] [Accepted: 04/16/2018] [Indexed: 11/17/2022] Open
Abstract
Hypertension is a major risk factor for heart disease and stroke. Affordability of medical care affects hypertension prevention, treatment, and control, but limited information is available for Chinese migrants with hypertensive state. Using Longitudinal Survey on Rural Urban Migration in China 2009 data, 2468 Chinese migrants reported hypertensive status. On the basis of comparison between medical payment and job income, participants were categorized as unaffordable and affordable. Thus, unaffordable expenses and unaffordable services were defined based on a public available survey. The descriptive statistics showed that 24.96% were at risk of prehypertension and mild-moderate-severe hypertension among 2468 Chinese migrants from 15 cities. Small part of the sample was not affordable to pay medical expenses and services. There were significant differences of hypertensive states between gender, marital status, regular smoker, and economic unaffordability. Multiple logistic regressions indicated that economic unaffordability had associations with abnormal weight, poor health assessment, and unhealthy hypertensive status. The alarming results may necessitate targeted interventions, even among people with good health status.
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Affiliation(s)
- Ming Guan
- Family Issues Center, Xuchang University, Road Bayi 88, Xuchang, Henan, China
- School of Business, Xuchang University, Road Bayi 88, Xuchang, Henan, China
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Wang H, Zhang D, Hou Z, Yan F, Hou Z. Association between social health insurance and choice of hospitals among internal migrants in China: a national cross-sectional study. BMJ Open 2018; 8:e018440. [PMID: 29440156 PMCID: PMC5829819 DOI: 10.1136/bmjopen-2017-018440] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 11/22/2017] [Accepted: 01/10/2018] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES There is a tendency to pursue higher-level hospitalisation services in China, especially for internal migrants. This study aims to investigate the choices of hospitalisation services among internal migrants, and evaluate the association between social health insurance and hospitalisation choices. METHODS Data were from a 2014 nationally representative cross-sectional sample of internal migrants aged 15-59 years in China. Descriptive analyses were used to perform the distribution of healthcare facility levels for hospitalisation services, and multinomial logistic regression was applied to examine the association between social health insurance and hospitalisation choices. RESULTS Of the 6121 inpatient care users, only 11.50% chose the primary healthcare facilities for hospitalisation services, 44.91% chose the secondary hospitals and 43.59% preferred the tertiary hospitals. The choices presented large regional variations across the country. Compared with the uninsured, social health insurance had no statistically significant effect on patient choices of healthcare facility levels among internal migrants in China, whereas socioeconomic status was positively associated with the choices. CONCLUSIONS Social health insurance had little influence on the hospital choice among the internal migrants. Thus, social health insurance should be consolidated and portable to enhance the proper incentive of health insurance on healthcare seeking behaviours.
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Affiliation(s)
- Haiqin Wang
- Department of Social Medicine, School of Public Health, National Key Laboratory of Health Technology Assessment (National Health and Family Planning Commission), Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai, China
| | - Donglan Zhang
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, Georgia, USA
| | - Zhiying Hou
- Shanghai Health Development Research Center, Shanghai, China
| | - Fei Yan
- Department of Social Medicine, School of Public Health, National Key Laboratory of Health Technology Assessment (National Health and Family Planning Commission), Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai, China
| | - Zhiyuan Hou
- Department of Social Medicine, School of Public Health, National Key Laboratory of Health Technology Assessment (National Health and Family Planning Commission), Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai, China
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Peng BL, Zou GY, Chen W, Lin YW, Ling L. Association between health service utilisation of internal migrant children and parents' acculturation in Guangdong, China: a cross-sectional study. BMJ Open 2018; 8:e018844. [PMID: 29331968 PMCID: PMC5781153 DOI: 10.1136/bmjopen-2017-018844] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To assess the health service utilisation of internal migrant children in Guangdong, China, and to explore the association between children's health service utilisation and their parents' acculturation. DESIGN Cross-sectional survey between April and May 2016. SETTING Six society-run schools of Tianhe and Baiyun districts in Guangzhou City of China. PARTICIPANTS We recruited all students at grade 7 or 8 and one of their parents who resided in Guangzhou over 6 months without permanent registered residence (hukou) in Guangzhou (1161 pairs completed this survey). 258 children were ill within the past 2 weeks or during the last year. MAIN OUTCOME MEASURES The main outcome was self-reported health service utilisation. Logistic regression analysis was conducted to explore the association between children's unmet needs for outpatient or inpatient service and their parents' acculturation (categorised into high, middle and low groups). RESULTS In total, 216 children, or 18.6% of the total subjects, were ill within the past 2 weeks and were in need of outpatient service; 94 children, or 8.1% of the total subjects, were in need of inpatient service. Among them, 17.6% and 46.8% of the migrant children had unmet needs for outpatient and inpatient services, respectively. After controlling for enabling resources and predisposing characteristics, migrant children with parents in the middle-acculturation group (adjusted OR=3.17, 95% CIs 1.2 to 8.3, P<0.05) were more likely to have an unmet outpatient need than high-acculturation or low-acculturation groups, although only statistically significant when comparing with the high-acculturation group. Stratified analysis suggested that this association could be moderated by their family economic status. CONCLUSIONS Our study suggested that the association between migrant children's health service utilisation and their parents' acculturation was complex and could be moderated by family economic status. Increasing the service utilisation among migrant children requires improving the acculturation and economic status of the parents of internal migrants.
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Affiliation(s)
- Bo-li Peng
- Center for Migrant Health Policy, Sun Yat-sen University, Guangzhou, China
| | - Guan-yang Zou
- Center for Migrant Health Policy, Sun Yat-sen University, Guangzhou, China
- Institute for International Health and Development, Queen Margaret University, Edinburgh, UK
| | - Wen Chen
- Center for Migrant Health Policy, Sun Yat-sen University, Guangzhou, China
- Faculty of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Yan-wei Lin
- Center for Migrant Health Policy, Sun Yat-sen University, Guangzhou, China
- Faculty of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Li Ling
- Center for Migrant Health Policy, Sun Yat-sen University, Guangzhou, China
- Faculty of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
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23
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Guan M. Should the poor have no medicines to cure? A study on the association between social class and social security among the rural migrant workers in urban China. Int J Equity Health 2017; 16:193. [PMID: 29115960 PMCID: PMC5678794 DOI: 10.1186/s12939-017-0692-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 11/01/2017] [Indexed: 12/01/2022] Open
Abstract
Background The rampant urbanization and medical marketization in China have resulted in increased vulnerabilities to health and socioeconomic disparities among the rural migrant workers in urban China. In the Chinese context, the socioeconomic characteristics of rural migrant workers have attracted considerable research attention in the recent past years. However, to date, no previous studies have explored the association between the socioeconomic factors and social security among the rural migrant workers in urban China. This study aims to explore the association between socioeconomic inequity and social security inequity and the subsequent associations with medical inequity and reimbursement rejection. Methods Data from a regionally representative sample of 2009 Survey of Migrant Workers in Pearl River Delta in China were used for analyses. Multiple logistic regressions were used to analyze the impacts of socioeconomic factors on the eight dimensions of social security (sick pay, paid leave, maternity pay, medical insurance, pension insurance, occupational injury insurance, unemployment insurance, and maternity insurance) and the impacts of social security on medical reimbursement rejection. The zero-inflated negative binomial regression model (ZINB regression) was adopted to explore the relationship between socioeconomic factors and hospital visits among the rural migrant workers with social security. Results The study population consisted of 848 rural migrant workers with high income who were young and middle-aged, low-educated, and covered by social security. Reimbursement rejection and abusive supervision for the rural migrant workers were observed. Logistic regression analysis showed that there were significant associations between socioeconomic factors and social security. ZINB regression showed that there were significant associations between socioeconomic factors and hospital visits among the rural migrant workers. Also, several dimensions of social security had significant associations with reimbursement rejections. Conclusions This study showed that social security inequity, medical inequity, and reimbursement inequity happened to the rural migrant workers simultaneously. Future policy should strengthen health justice and enterprises’ medical responsibilities to the employed rural migrant workers. Electronic supplementary material The online version of this article (10.1186/s12939-017-0692-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ming Guan
- Family Issues Center, Xuchang University, Road Bayi 88, Xuchang, Henan, China. .,School of Business, Xuchang University, Road Bayi 88, Xuchang, Henan, China.
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Chen W, Zhang Q, Renzaho AMN, Zhou F, Zhang H, Ling L. Social health insurance coverage and financial protection among rural-to-urban internal migrants in China: evidence from a nationally representative cross-sectional study. BMJ Glob Health 2017; 2:e000477. [PMID: 29082027 PMCID: PMC5652549 DOI: 10.1136/bmjgh-2017-000477] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Accepted: 09/27/2017] [Indexed: 12/05/2022] Open
Abstract
Introduction Migrants are a vulnerable population and could experience various challenges and barriers to accessing health insurance. Health insurance coverage protects migrants from financial loss related to illness and death. We assessed social health insurance (SHI) coverage and its financial protection effect among rural-to-urban internal migrants (IMs) in China. Methods Data from the ‘2014 National Internal Migrant Dynamic Monitoring Survey’ were used. We categorised 170 904 rural-to-urban IMs according to their SHI status, namely uninsured by SHI, insured by the rural SHI scheme (new rural cooperative medical scheme (NCMS)) or the urban SHI schemes (urban employee-based basic medical insurance (UEBMI)/urban resident-based basic medical insurance (URBMI)), and doubly insured (enrolled in both rural and urban schemes). Financial protection was defined as ‘the percentage of out-of-pocket (OOP) payments for the latest inpatient service during the past 12 months in the total household expenditure’. Results The uninsured rate of SHI and the NCMS, UEBMI/URBMI and double insurance coverage in rural-to-urban IMs was 17.3% (95% CI 16.9% to 17.7%), 66.6% (66.0% to 67.1%), 22.6% (22.2% to 23.0%) and 5.5% (5.3% to 5.7%), respectively. On average, financial protection indicator among uninsured, only NCMS insured, only URBMI/UEBMI insured and doubly insured participants was 13.3%, 9.2%, 6.2% and 5.8%, respectively (p=0.004). After controlling for confounding factors and adjusting the protection effect of private health insurance, compared with no SHI, the UEBMI/URBMI, the NCMS and double insurance could reduce the average percentage share of OOP payments by 33.9% (95% CI 25.5% to 41.4%), 14.1% (6.6% to 20.9%) and 26.8% (11.0% to 39.7%), respectively. Conclusion Although rural-to-urban IMs face barriers to accessing SHI schemes, our findings confirm the positive financial protection effect of SHI. Improving availability and portability of health insurance would promote financial protection for IMs, and further facilitate achieving universal health coverage in China and other countries that face migration-related obstacles to achieve universal coverage.
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Affiliation(s)
- Wen Chen
- Faculty of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Qi Zhang
- School of Community and Environmental Health, Old Dominion University, Norfolk, Virginia, USA
| | - Andre M N Renzaho
- School of Social Science and Psychology, Humanitarian and Development Research Initiative, Western Sydney University - Penrith Campus, Kingswood, New South Wales, Australia
| | - Fangjing Zhou
- Department of Prevention and Treatment, Center for Tuberculosis Control of Guangdong Province, Guangzhou, China
| | - Hui Zhang
- Faculty of Health Policy and Management, School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Li Ling
- Faculty of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-Sen University, Guangzhou, China
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25
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Regional Maldistribution of China’s Hospitals Based on Their Structural System. SUSTAINABILITY 2017. [DOI: 10.3390/su9061046] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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26
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Huang Z, Pan Z. Improving migrants’ access to the public health insurance system in China: A conceptual classification framework. ASIAN AND PACIFIC MIGRATION JOURNAL 2017. [DOI: 10.1177/0117196817705779] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Although the Chinese government has established a public health insurance system covering both rural and urban areas, the rural–urban migrants seem to have been neglected. To have a clear sense of the current status of migrants in the public health insurance system and to find ways to increase their enrollment to medical insurance, this paper attempts to construct a conceptual classification framework of China’s health insurance system. This was done by reviewing the development of China’s health insurance system and identifying barriers to entry for migrants. The finding suggests that migrants’ limited access to health insurance owes more to their reluctance than to system exclusions. The job and residential stability of migrants are critical factors to building the classification framework to account for supply and demand factors in the formulation of China’s health insurance policy.
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27
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Song X, Zou G, Chen W, Han S, Zou X, Ling L. Health service utilisation of rural-to-urban migrants in Guangzhou, China: does employment status matter? Trop Med Int Health 2016; 22:82-91. [PMID: 27775826 DOI: 10.1111/tmi.12801] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To describe the self-reported health status and service utilisation of employed, retired and unemployed migrants in Guangzhou, a megacity in southern China. METHODS A cross-sectional study adapted from the National Health Service Survey was conducted between September and December in 2014. Based on the distribution of occupation of migrants, multistage sampling was used to recruit individuals. Logistic regression was applied to explore the factors influencing their service utilisation. RESULTS Of 2906 respondents, 76.6% were employed, 9.2% retired and 14.2% unemployed. Only 8.1% reported having an illness in the previous 2 weeks, and 6.5% reported having been hospitalised in the previous year. Employed migrants had the lowest recent physician consultation rate (3.4%) and the lowest annual hospitalisation rate (4.5%) (P < 0.05); unemployed migrants had the highest rates (6.8% and 14.5% respectively, P < 0.05). Retired migrants were more likely to return to their hometown for health care (8.6%) than employed (1.5%) and unemployed migrants (3.4%) (P < 0.05). After adjusting for age and gender, employment status remained significant in explaining the recent two-week treatment-seeking behaviour of migrants (P < 0.05). CONCLUSION Disparity of service utilisation continues to be a problem for migrants due to the poor health awareness, lack of time and inconvenience of medical insurance reimbursement. Employed migrants make the least use of health services.
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Affiliation(s)
- Xiaolei Song
- Faculty of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China.,Sun Yat-sen Center for Migrant Health Policy, Sun Yat-sen University, Guangzhou, China
| | - Guanyang Zou
- Sun Yat-sen Center for Migrant Health Policy, Sun Yat-sen University, Guangzhou, China.,Institute for International Health and Development, Queen Margaret University, Edinburgh, UK
| | - Wen Chen
- Faculty of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China.,Sun Yat-sen Center for Migrant Health Policy, Sun Yat-sen University, Guangzhou, China
| | - Siqi Han
- Faculty of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China.,Sun Yat-sen Center for Migrant Health Policy, Sun Yat-sen University, Guangzhou, China
| | - Xia Zou
- Faculty of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China.,Sun Yat-sen Center for Migrant Health Policy, Sun Yat-sen University, Guangzhou, China
| | - Li Ling
- Faculty of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China.,Sun Yat-sen Center for Migrant Health Policy, Sun Yat-sen University, Guangzhou, China
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28
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Chung VCH, Wong SYS, Wang HHX, Wong MCS, Wei X, Wang J, Liu S, Ho RST, Yu ELM, Griffiths SM. Use of Traditional and Complementary Medicine as Self-Care Strategies in Community Health Centers: Cross-Sectional Study in Urban Pearl River Delta Region of China. Medicine (Baltimore) 2016; 95:e3761. [PMID: 27281074 PMCID: PMC4907652 DOI: 10.1097/md.0000000000003761] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 04/22/2016] [Accepted: 04/02/2016] [Indexed: 01/10/2023] Open
Abstract
In China, Community Health Centers (CHCs) are major providers of primary care services, but their potential in empowering patients' self-management capacity has not been assessed. This study aims to describe self-care practice patterns amongst CHC attendees in urban China.In this cross-sectional quantitative study, 3360 CHC patients from 6 cities within the Pearl Delta Region were sampled using multistage cluster sampling.Thirty-seven per cent had used with over-the-counter Chinese herbal medicines (OTC CHMs) in the past year and majority of respondents found OTC CHMs effective. OTC CHMs were more popular amongst those who needed to pay out of pocket for CHC services. Less than 10% used vitamins and minerals, and those with a lower socioeconomic background have a higher propensity to consume. Although doubts on their usefulness are expressed, their use by the vulnerable population may reflect barriers to access to conventional health care, cultural affinity, or a defense against negative consequences of illnesses. About 25% performed physical exercise, but the prevalence is lower amongst women and older people. Taiji seems to be an alternative for these populations with promising effectiveness, but overall only 6% of CHC attendees participated.These results suggest that CHCs should start initiatives in fostering appropriate use of OTC CHM, vitamins, and minerals. Engaging community pharmacists in guiding safe and effective use of OTC CHM amongst the uninsured is essential given their low accessibility to CHC services. Prescription of Taiji instead of physical exercises to women and older people could be more culturally appropriate, and the possibility of including this as part of the CHC services worth further exploration.
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Affiliation(s)
- Vincent C H Chung
- From the JC School of Public Health and Primary Care (VCHC, SYSW, MCSW, XW, SL, RSTH, ELMY, SMG); Hong Kong Institute of Integrative Medicine (VCHC, SYSW), The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR; School of Public Health (HHXW), Sun Yat-Sen University; School of Public Health (JW), Guangzhou Medical University, Guangzhou, Guangdong Province, China; and Institute of Global Health Innovation (SMG), Imperial College London, London, UK
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Du Q, Zhang M, Li Y, Luan H, Liang S, Ren F. Spatial Patterns of Ischemic Heart Disease in Shenzhen, China: A Bayesian Multi-Disease Modelling Approach to Inform Health Planning Policies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:436. [PMID: 27104551 PMCID: PMC4847098 DOI: 10.3390/ijerph13040436] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 03/31/2016] [Accepted: 04/13/2016] [Indexed: 11/26/2022]
Abstract
Incorporating the information of hypertension, this paper applies Bayesian multi-disease analysis to model the spatial patterns of Ischemic Heart Disease (IHD) risks. Patterns of harmful alcohol intake (HAI) and overweight/obesity are also modelled as they are common risk factors contributing to both IHD and hypertension. The hospitalization data of IHD and hypertension in 2012 were analyzed with three Bayesian multi-disease models at the sub-district level of Shenzhen. Results revealed that the IHD high-risk cluster shifted slightly north-eastward compared with the IHD Standardized Hospitalization Ratio (SHR). Spatial variations of overweight/obesity and HAI were found to contribute most to the IHD patterns. Identified patterns of IHD risk would benefit IHD integrated prevention. Spatial patterns of overweight/obesity and HAI could supplement the current disease surveillance system by providing information about small-area level risk factors, and thus benefit integrated prevention of related chronic diseases. Middle southern Shenzhen, where high risk of IHD, overweight/obesity, and HAI are present, should be prioritized for interventions, including alcohol control, innovative healthy diet toolkit distribution, insurance system revision, and community-based chronic disease intervention. Related health resource planning is also suggested to focus on these areas first.
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Affiliation(s)
- Qingyun Du
- School of Resources and Environmental Science, Wuhan University, 129 Luoyu Road, Wuhan 430079, China.
- Key Laboratory of GIS, Ministry of Education, Wuhan University, 129 Luoyu Road, Wuhan 430079, China.
- Key Laboratory of Digital Mapping and Land Information Application Engineering, National Administration of Surveying, Mapping and Geoinformation, Wuhan University, 129 Luoyu Road, Wuhan 430079, China.
- Collaborative Innovation Center of Geospatial Technology, Wuhan University, 129 Luoyu Road, Wuhan 430079, China.
| | - Mingxiao Zhang
- School of Resources and Environmental Science, Wuhan University, 129 Luoyu Road, Wuhan 430079, China.
| | - Yayan Li
- School of Resources and Environmental Science, Wuhan University, 129 Luoyu Road, Wuhan 430079, China.
| | - Hui Luan
- School of Planning, Faculty of Environment, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1, Canada.
| | - Shi Liang
- Shenzhen Prevention and Treatment Center for Occupational Diseases, Guiyuan Street North 70, Luohu District, Shenzhen 518001, China.
| | - Fu Ren
- School of Resources and Environmental Science, Wuhan University, 129 Luoyu Road, Wuhan 430079, China.
- Key Laboratory of GIS, Ministry of Education, Wuhan University, 129 Luoyu Road, Wuhan 430079, China.
- Key Laboratory of Digital Mapping and Land Information Application Engineering, National Administration of Surveying, Mapping and Geoinformation, Wuhan University, 129 Luoyu Road, Wuhan 430079, China.
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30
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Liu H, Rizzo JA, Fang H. Urban-rural disparities in child nutrition-related health outcomes in China: The role of hukou policy. BMC Public Health 2015; 15:1159. [PMID: 26596931 PMCID: PMC4657335 DOI: 10.1186/s12889-015-2517-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 11/18/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hukou is the household registration system in China that determines eligibility for various welfare benefits, such as health care, education, housing, and employment. The hukou system may lead to nutritional and health disparities in China. We aim at examining the role of the hukou system in affecting urban-rural disparities in child nutrition, and disentangling the institutional effect of hukou from the effect of urban/rural residence on child nutrition-related health outcomes. METHODS This study uses data from the China Health and Nutrition Survey 1993-2009 with a sample of 9616 children under the age of 18. We compute height-for-age z-score and weight-for-age z-score for children. We use both descriptive statistics and multiple regression techniques to study the levels and significance of the association between child nutrition-related health outcomes and hukou type. RESULTS Children with urban hukou have 0.25 (P < 0.01) higher height z-scores and 0.15 (P < 0.01) higher weight z-scores than children with rural hukou, and this difference by urban vs. rural hukou status is larger than the difference in height and weight (0.23 and 0.09, respectively) by urban vs. rural residence. Controlling for place of residence, children with urban hukou had 0.18 higher height z-scores and 0.17 (P < 0.01) higher weight z-scores than children with rural hukou. CONCLUSIONS The hukou system exacerbates urban-rural disparities in child nutrition-related health outcomes independent of the well-known disparity stemming from urban-rural residence. Fortunately, however, child health disparities due to hukou have been declining since 2000.
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Affiliation(s)
- Hong Liu
- China Economics and Management Academy, Central University of Finance and Economics, Beijing, 100081, China.
| | - John A Rizzo
- Department of Economics and Department of Preventive Medicine, Stony Brook University, Stony Brook, 11794, USA.
| | - Hai Fang
- China Center for Health Development Studies, Peking University, 38 Xueyuan Road, Haidian District, PO Box 505, Beijing, 100191, China.
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31
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Zou G, Zeng Z, Chen W, Ling L. Self-reported illnesses and service utilisation among migrants working in small-to medium sized enterprises in Guangdong, China. Public Health 2015; 129:970-8. [PMID: 26077388 DOI: 10.1016/j.puhe.2015.04.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 04/06/2015] [Accepted: 04/22/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVES As one of the most vulnerable populations in China, many migrants work in the small-to-medium-sized enterprises (SMEs). This study aims to describe the self-reported illnesses and service utilization of the migrants working in the SMEs in Pearl River Delta Areas (PRDA) of Guangdong province, China. STUDY DESIGN Cross-sectional survey. METHODS We interviewed 856 migrants working in the SMEs of different manufacturing industries in 2012. Descriptive analysis was employed to report self-reported illnesses and service utilisation among migrants in the last two weeks and in the last year. Statistical tests such as χ2 test were used to explore factors influencing their service utilisation. RESULTS In the last two weeks, 91(11%) of the respondents reported having any illness. The most reported illness was respiratory problem (69%), while 9.9%, 7.7% and 13% reported having digestive, skin and other problems respectively. The most important symptom was cough (39%). Thirty-seven percent of the respondents who reported any illness had visited health facilities. The lower income group were more likely to visit health facilities than the higher income group (P = 0.006). The most reported reason for not visiting health facilities was 'feeling not serious' (65%). In the last year, 13% reported having respiratory problems and 7.8% reported accidental injuries. Less than 3% received hospitalization care. The proportion of those without hospitalization to those who should have been hospitalized was 31%. CONCLUSION Underuse of the health service among migrants working in the SMEs could be associated with the 'healthy migrant' effect. However, when assessed among the ill migrants in the SMEs, the utilisation rate was still low mainly due to their poor health awareness. Improving their risk perception and integration of occupational and general health service is crucial to improve the health conditions and utilisation of service among migrants in the SMES.
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Affiliation(s)
- G Zou
- Sun Yat-sen Center for Migrant Health Policy, Sun Yat-sen University, Guangzhou, China; Institute for International Health and Development, Queen Margaret University, Edinburgh, UK
| | - Z Zeng
- Sun Yat-sen Center for Migrant Health Policy, Sun Yat-sen University, Guangzhou, China; Hunan Provincial Women and Children's Hospital, Changsha, Hunan, China
| | - W Chen
- Sun Yat-sen Center for Migrant Health Policy, Sun Yat-sen University, Guangzhou, China; Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - L Ling
- Sun Yat-sen Center for Migrant Health Policy, Sun Yat-sen University, Guangzhou, China; Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China.
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Abstract
BACKGROUND This study describes the prevalence of depression symptoms and its impact on health-seeking behaviour among Chinese migrant workers in a sample of 1,533 Shenzhen residents. METHODS A cross-sectional questionnaire survey was administered in Shenzhen with a random sample of 859 registered and 674 non-registered residents. The 20-item Centre for Epidemiologic Studies-Depression Scale (CES-D) scale was used to measure depression symptoms. Multivariate regression analysis was applied to assess healthcare services utilisation. RESULTS Non-registered residents were more likely to have clinically significant depressive symptoms (CES-D score ≥ 16) (odds ratio (OR) = 1.81; confidence interval (CI) = 1.18, 2.76). Despite this, depressed non-registered residents had no significant difference in health-seeking behaviour when compared to those without depression (OR = 2.86; CI = 0.98, 8.32), while in contrast, depressed registered residents had a positive and stronger association with healthcare services utilisation and/or self-medication (OR = 3.34; CI = 1.28, 8.71). CONCLUSION The findings suggest higher prevalence of depression but less utilisation of healthcare services or self-medication among migrant residents. That migrants with depression lack access to healthcare suggests healthcare inequality. Psychological disorders require careful management and treatment; the mismatch in their health needs and access to care may contribute to the Inverse-care law.
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Affiliation(s)
- Kelvin K F Lam
- School of Public Health, Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Janice M Johnston
- School of Public Health, Faculty of Medicine, The University of Hong Kong, Hong Kong
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Lin C, Cao X, Li L. Integrating antiretroviral therapy in methadone maintenance therapy clinics: service provider perceptions. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2014; 25:1066-70. [PMID: 24939555 DOI: 10.1016/j.drugpo.2014.04.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 04/28/2014] [Accepted: 04/30/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Using methadone maintenance therapy (MMT) clinics to deliver antiretroviral therapy (ART) is an effective strategy to promote treatment initiation and adherence for HIV-positive drug users. This paper describes the implementation barriers perceived by service providers for an intervention pilot designed to integrate ART services in MMT clinics. METHODS The study was conducted in six MMT clinics in Sichuan province, China. Two service providers selected from each of the six clinics underwent training in administering ART. The trained providers delivered ART-related services in their clinics. A focus group was conducted among the service providers to assess their experiences and perceived challenges in delivering integrated services. RESULTS Barriers at policy, institutional, provider, and client levels were identified. Policy level barriers included household registration restrictions and a lack of insurance coverage for testing expenses. Inefficient coordination between treatment sites and MMT clinics was an obstacle at the institutional level. Insufficient training and added workload were barriers at the provider level. Finally, conflict with daily dosing habits was identified as the primary reason that clients did not accept ART. CONCLUSION Although integrating ART into MMT clinics is beneficial, multilevel barriers to implementation need to be addressed. This study documents the need for treatment transferability and insurance coverage, protection of client confidentiality, proper provider training, coordination with treatment sites, and individualized ART service for MMT clients.
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Affiliation(s)
- Chunqing Lin
- Semel Institute for Neuroscience and Human Behavior, Center for Community Health, University of California at Los Angeles, Los Angeles, CA, USA.
| | - Xiaobin Cao
- National Center for AIDS Prevention and Control, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Li Li
- Semel Institute for Neuroscience and Human Behavior, Center for Community Health, University of California at Los Angeles, Los Angeles, CA, USA
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